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A persistent view of oneself as fat that worsens despite weight loss

Understanding eating disorders

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As many as 10 million females and 1 million males in the U.S. have anorexia or bulimia. As many as 13million more struggle
with a binge-eating disorder.

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Eating disorders affect people from all walks of life, including young children, middle-age women, men and individuals of
all races and ethnicities.

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The peak onset of eating disorders occurs during puberty and the late teen and early adult years, but symptoms can occur
as young as kindergarten.

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A recent study of hospitalizations related to eating disorders cites data showing a sharp increase from 1999 to 2006, up
18 percent overall, 24 percent among the elderly, 37 percent among men and 119 percent among children younger than 12 (although
that age group accounts for fewer than 5 percent of cases).

When Michael Whitehead started losing weight almost three years ago, it seemed like a good
thing.

"I was overweight and made fun of for most of my life. Relentlessly," said the Fairfield County
teen. "But then I became extremely obsessive."

He dropped more than 100 pounds in six months. He began to eliminate many foods from his
diet, eating almost no fat. At his lowest point, he ate about 700 calories a day and exercised at
least three hours.

He felt that he couldn't stop.

Whitehead was 16 when a doctor diagnosed anorexia. At one point, the 5-foot 9-inch teen had
shrunk to 120 pounds.

He now is 18 and a senior at Amanda-Clearcreek High School. He has been through two
inpatient-care programs and continues to get care at Nationwide Children's Hospital. His weight is
up to about 180 pounds, and he's on medication that helps ease the obsessive-compulsive disorder
that helped fuel his illness.

Whitehead is troubled by advertising that depicts young men who are impossibly thin and yet
still have muscles. Images such as that contribute to the disorder by encouraging people to attain
an impossible physique, to seek "perfection," he said.

And he's adamant that people, including doctors, should be better at recognizing eating
disorders in boys and men. Initially, he said, doctors "were like, 'Oh yeah, you're a guy, you
can't have an eating disorder.'

"I think that society really needs to know that this is not just a female problem."

A population-based study published in 2007 found that men and boys were one-third as likely as
women to have anorexia or bulimia and more than half as likely to have a binge-eating disorder.

"I think it's still viewed as a predominantly female disorder, and I think that's going to be a
hard thing to change," said Dr. Terry Bravender, chief of adolescent medicine at Children's.

There are many obstacles, including doctors who don't recognize it and patients and families who
resist getting help, he said. "I've seen boys and young men embarrassed to come in because they
think they have a girls' disorder. And I think a lot of times boys have to be really impaired to be
identified as having an eating disorder."

In male patients, problems typically arise a little differently, he said. They often start to
eat healthier and exercise more in hopes of building muscle. Then other mental illnesses -
including obsessive-compulsive disorder, depression and anxiety - lead to development of the
disease.

Anorexia and bulimia can lead to osteoporosis, heart problems and, in the most extreme cases,
death.

Signs of eating disorders should be taken seriously, and professional help is essential, said
Lynn Grefe, president and CEO of the National Eating Disorders Association.

Those involved with someone who is ill should take care not to approach the situation with anger
or find fault with the patient or his family, she said.

"It's not their fault. Nobody is to blame here," Grefe said. "Blame can really get in the way of
treatment."

She said she has heard more stories about men with eating disorders in recent years and pointed
to one study that suggests hospitalizations are increasing faster among males than females.

Recognition of eating disorders in men - preferably earlier on, before serious damage has
occurred - must improve, said Grefe, whose organization is working to increase physician education
on identification of the disease in both genders.

Laura Hill, CEO of the Center for Balanced Living in Worthington, said there's work afoot to
change the mental-illness diagnostic manual that psychiatrists and others use. She said the manual
is skewed toward women. The diagnosis for anorexia, for example, includes criteria based on the
patient's menstrual cycle.

"It's underdiagnosed," she said. "You're looking at other things ... and it often only surfaces
after you've eliminated and ruled out other problems."

Family and friends play an important role in helping patients get well, Hill said, and their
support and understanding go a long way toward recovery.

Whitehead said, "The worst thing you can do is try to make them eat. You need to tell them that
you care and that you love them and try to help them get some professional help."